Reumatologia

Researchers at University Duisburg-Essen, Germany have discovered new blood vessels in the long bones of mice, as well as similar new vessels in human long bones.

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The vessels, which the scientists have called “trans-cortical vessels” (TCVs), were found to have originate in the bone marrow and traverse cortical bone perpendicularly along the shaft and connect to the periosteal circulation.

The finding, which was recently published in the journal Nature Metabolism, could help to improve understanding of bone diseases such as osteoporosis and immune system disorders.

Scientists were already aware that a few blood vessels exist at the ends of bones or half way along them, but little is known about how blood enters and leaves long bones.

Given this limited knowledge, Matthias Gunzer and colleagues decided to study blood vessel distribution in the long bones of mice using techniques that have only recently been made available or never been previously used in this field.

Analysis of the lower leg bone using light-sheet fluorescence microscopy and X-ray microscopy showed TCVs crossing the bone shaft, covering the whole bone and constituting most of the bone’s blood supply.

It’s totally crazy there are still things to find out about human anatomy – we have discovered blood vessels in a new place that we didn’t know about before.”

Matthias Gunzer, Study Author

The study also revealed that humans have vessels that resemble TCVs in the thigh bone. Analysis of tiny samples taken from the neck of the human femur identified vessels that were structurally similar to (although much wider than) the ones seen in the mouse model.

Taken together, these data suggest that human long bones, at least in some areas, also possess a system of TCVs that directly connects the vascular system of the BM to the peripheral circulation through cortical bone.”

Gunzer and colleagues point out that diseases affecting bone physiology are known to cause substantial changes in TCV numbers.

“Since key bone pathologies are associated with alterations in the TCV system, entirely new research possibilities that further characterize the role of TCVs in skeletal biology and disease can be envisioned.”

Curtir isso:

Ankylosing spondylitis is a form of arthritis that mainly affects the spine and sacroiliac joints, or the lower back.

An inflammatory disease, symptoms of ankylosing spondylitis (AS) include pain, stiffness, and loss of mobility. The disease involves erosion of bone and increased bone formation in the spine, leading to bone fusion. In advanced cases, this can lead to spinal deformity.

AS most commonly occurs in men in their teens and 20s, but it can affect anyone of any age. It tends to be milder when it does occur in women, making it harder to diagnose.

Drug treatments and physical therapy can help relieve symptoms.

Fast facts on ankylosing spondylitis (AS):

Ankylosing spondylitis is a type of arthritis.

It mostly affects the lower part of the spine, and where it joins to the hips, known as the sacroiliac joints.

Ankylosing spondylitis can be difficult to diagnose but has a particular pattern of pain symptoms, and changes can be seen on X-ray and MRI.

There is no cure, but drugs can help manage the pain and inflammation. Physical therapy can also relieve and prevent some of the effects.

Symptoms

One of the common symptoms of ankylosing spondylitis is lower back pain.

The three main symptoms of AS are:

pain

stiffness

loss of mobility

Pain is the main symptom, especially in the lower back and buttock areas during the early stages.

However, inflammation and pain are not confined to the spine. It is a systemic condition, which means it can affect other parts of the body.

These include:

other joints

the neck

the top of the shin bone in the lower leg

behind the heel of the foot, in the Achilles tendon

under the heel of the foot

AS can cause so-called bony fusion, an overgrowth of bones at the joints. This can make it difficult to carry out everyday tasks. In some cases, it can restrict movement of the chest and make it hard to breathe.

People with AS may also experience fatigue, a feeling of being tired and lacking energy.

AS can also affect the eyes, including the iris and other parts. This inflammation, known as iritis or uveitis, depending on the location, can cause redness and pain. It can impair vision if not treated.

Other systemic signs of the disease may include neurological and cardiovascular changes.

Below is a 3-D model of ankylosing spondylitis, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about ankylosing spondylitis.

Treatment

There is no cure for AS, and the damage cannot be reversed. However, some options can help relieve symptoms and manage progression.

These include:

physical therapies and exercises

advice

drugs

surgery, in rare cases

The person will need to see a specialist doctor, known as a rheumatologist. They may need a number of visits, as the disease progresses slowly. Medical care enables better monitoring and treatment.

Two approaches commonly used to manage AS are:

drugs to reduce pain and inflammation

physical therapy and exercises to maintain movement and posture

Surgery is used only rarely, in severe cases, to correct severe deformity, such as excessive bending of the spine, or to replace a hip or other joint.

Drug treatment

The main drugs used to ease the pain and inflammation of AS are nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include ibuprofen, naproxen, and diclofenac. Acetaminophen and codeine are also options if NSAIDs are unsuitable or insufficient.

Some NSAIDs compromise bone health by reducing the creation of new bone, and NSAIDs are not usually recommended after surgery for people with bone fusion problems.

TNF treatment appears to be effective, but it is expensive and can have adverse effects.

AS can affect the whole body, and patients may meet with a range of specialists, including physical therapists, eye specialists, and gastroenterologists.

Exercises

Physical therapy can help relieve the symptoms of ankylosing spondylitis.

Physical therapy and exercises can help prevent symptoms.

A physical therapist will design a program that can help patients maintain good posture and motion in the joints.

This might include:

daily exercises

special training

therapeutic exercises

Physical therapy exercises are referred to as strengthening exercises and range-of-motion exercises.

Here are two exercises, suggested by the U.K. charity, Arthritis Research:

Stand with your back and heels against a wall, and push your head back to touch the wall. Do not tilt the head back. Hold for 5 seconds, relax, and repeat for up to 10 times.

Stand with the feet apart and hands on hips. Turn to one side, hold for 5 seconds, and relax. Repeat on the other side. Do this five times on each side.

There are different ways to exercise, including water fitness. A doctor can recommend a suitable plan.

Diagnosis

A doctor will ask about symptoms, carry out a physical examination, and arrange for tests where necessary.

If inflammatory back pain is present with certain features, this may indicate AS.

The features include:

pain that does not improve with rest

pain that causes sleep disturbance

back pain that starts gradually, before the age of 40 years, and is not caused by injury

symptoms that persist for over 3 months

spinal stiffness in the mornings, which improves with exercise and motion

Imaging tests may confirm the diagnosis, but changes may not be immediately visible on such tests. This can delay diagnosis.

Blood tests

No blood test can confirm AS, but tests can help confirm diagnosis and rule out other causes.

The tests for inflammation may include:

erythrocyte sedimentation rate (ESR)

C-reactive protein (CRP)

complete blood count (CBC)

genetic test (HLA B27)

If other causes, such as rheumatoid arthritis (RA) are suspected, testing for rheumatoid factor (RF), cyclic citrullinated peptide (CCP), and antinuclear antibodies (ANA) can help rule out these conditions.

Imaging tests

These may include:

X-rays, which can reveal both early and more advanced changes to the spine and pelvis

MRI, for example, an MRI of sacroiliac (SI) joints can reveal early signs of the condition

Causes

The exact cause of AS remains unclear, but the symptoms result from inflammation in parts of the lower spine.

When new bone grows, this inflammation can lead to damage and fusion. The fusion can happen as a result of the inflammation of the tissues that connect to bones.

However, it is not yet known why this chronic inflammatory process occurs in people with ankylosing spondylitis.

The condition often runs in families and is known to have a genetic component.

Outlook

The prognosis for AS is difficult to predict, as it varies widely between individuals, and the progression is often not constant.

Important factors for measuring outlook include levels of functional ability, spinal mobility, joint damage, and so on. Some people will experience severe functional loss, some hardly notice their symptoms, and around 1 percent experience remission, where symptoms cease to develop.

A few people will have life-threatening complications, affecting the heart, lungs, or intestines.

Males who develop symptoms at a younger age are more likely to have severe damage and loss of mobility, but in women, the impact appears to be less severe.

As you age, your chance of developing osteoarthritis, which is caused by wear and tear, increases. The joint damage associated with osteoarthritis causes swelling, pain, and deformity. Here is information about how osteoarthritis affects the foot and ankle and information you can use to help you manage this debilitating condition.

What Is Arthritis?

Arthritis is a general term for a group of more than 100 diseases. The word “arthritis” means “joint inflammation.” Arthritis involves inflammation and swelling in and around the body’s joints and surrounding soft tissue. The inflammation can cause pain and stiffness.

In many kinds of arthritis, progressive joint deterioration occurs and the smooth “cushioning” cartilage in joints is gradually lost. As a result, the bones rub and wear against each other. Soft tissues in the joints also may begin to wear down. Arthritis can be painful and eventually result in limited motion, loss of joint function, and deformities in the joints affected.

What Is Osteoarthritis?

Osteoarthritis, or “wear-and-tear” arthritis, is the most common type of arthritis. Also known as degenerative joint disease or age-related arthritis, osteoarthritis is more likely to develop as people age. Inflammation and injury to the joint cause a breaking down of cartilage tissues, resulting in pain, swelling, and deformity. The changes in osteoarthritis usually occur slowly over many years, though there are occasional exceptions.

How Does Osteoarthritis Affect the Foot and Ankle?

Each foot has 28 bones and more than 30 joints. The following are the most common foot joints affected by osteoarthritis:

The three joints of the foot that involve the heel bone, the inner mid-foot bone, and the outer mid-foot bone

Tips on Foot Care With Osteoarthritis

The most essential element of foot care for people with foot and ankle osteoarthritis is to wear shoes that fit properly and feel comfortable. The following are things to look for in finding a comfortable shoe:

Shoes shaped like your foot

Shoes that have support — for example, no slip-on shoes

Rubber soles to provide more cushioning

Flexibility

Proper fit — ask the salesperson to help you with this

Exercise can help keep your feet pain-free, strong, and flexible. Exercises that can be good for your feet include:

Achilles stretch. With your palms flat on a wall, lean against the wall and place one foot forward and one foot back. Lean forward, leaving your heels on the floor. You can feel the pull in your Achilles tendon and your calf. Repeat this exercise three times, holding for 10 seconds on each repeat.

Big-toe stretch. Place a thick rubber band around your big toes. Pull the big toes away from each other and toward the other toes. Hold this position for five seconds and repeat the exercise 10 times.

Toe pull. Place a rubber band around the toes of each foot, and then spread your toes. Hold this position for five seconds and repeat the exercise 10 times.

Toe curl. Pick up marbles with your toes.

Is Surgery an Option for Foot and Ankle Osteoarthritis?

More than one kind of surgery may be required to treat foot and ankle osteoarthritis. Your doctor can select the kind of surgery that is best for you, depending on the extent of your arthritis. The following are some of the surgical options for foot and ankle osteoarthritis:

Fusion surgery. This kind of surgery, also called arthrodesis, involves fusing bones together with the use of rods, pins, screws, or plates. After healing, the bones remain fused together.

Joint replacement surgery. This kind of surgery involves replacing the ankle joint with artificial implants and is used only in rare cases.